Malignant-functioning neuroendocrine tumors of the pancreas: A survival analysis
Malignant-functioning neuroendocrine tumors of the pancreas: A survival analysis
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DOI：
10.1016/j.surg.2015.11.010
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发表时间：
2016-05-01
期刊：
影响因子：
3.8
通讯作者：
Kebebew, Electron
中科院分区：
文献类型：
--
作者：
Keutgen, Xavier M.;Nilubol, Naris;Kebebew, Electron
背景恶性功能性胰腺神经内分泌肿瘤（mFpNETs）是罕见的。分析这些肿瘤的表现、生物学行为和患者结局的研究有限。我们使用监测、流行病学和最终结果数据库来识别恶性胰岛素瘤、胃泌素瘤、胰高血糖素瘤、血管活性肠肽分泌肿瘤（VIP瘤）、生长激素瘤和混合性胰岛细胞瘤（MICTs）患者。本研究的主要终点是确定影响生存率的因素。我们确定了401例mFpNET患者。在组织学亚型之间，性别、年龄、肿瘤大小、分级、位置和分期存在显著差异。胰岛素瘤的中位生存时间为12.7年;胃泌素瘤为10.2年;胰高血糖素瘤为7.7年; VIP瘤为7.9年; MICTs为3.4年。多变量分析显示，组织学（胰岛素瘤、胃泌素瘤和VIPoma; P = 0.009）、无远处转移（P = 0.002）、年龄< 50岁（P = 0.001）、手术干预（P = 0.001）和I/II期疾病（P = 0.011）与生存期延长独立相关。亚组分析表明，IV期mFpNETs原发肿瘤切除与生存期显著延长相关（P = 0.01）。inFpNET是罕见的肿瘤，通常存在于晚期，尽管有激素分泌。原发性肿瘤切除术与分期以及IV期肿瘤的较长生存期相关。
Background. Malignant functioning pancreatic neuroendocrine tumors (mFpNETs) are rare. Research analyzing the presentation, biological behavior, and patient outcomes of these tumors is limited.Methods. We used the Surveillance, Epidemiology, and End Results database to identify patients with malignant insulinomas, gastrinomas, glucagonomas, vasoactive intestinal peptide secreting tumors (VIPomas), somastatinomas, and mixed islet cell tumors (MICTs). The primary endpoint of this study was to identify factors affecting survival.Results. We identified 401 patients with mFpNETs. Between histologic subtypes, there were significant differences in sex and age, and in tumor size, grade, location, and stage. Median survival time for insulinomas was 12.7 years; gastrinomas, 10.2 years; glucagonomas, 7.7 years; VIPomas, 7.9 years; and MICTs, 3.4 years. Multivariable analysis showed that histology (insulinoma, gastrinoma, and VIPoma; P = .009), absence of distant metastases (P = .002), age < 50 years (P = .001), surgical intervention (P = .001), and stage I/II disease (P = .011) were independently associated with prolonged survival. Subgroup analysis demonstrated that removal of the primary tumor in stage IV mFpNETs was associated with significantly prolonged survival (P = .01).Conclusion. inFpNETs are rare tumors that commonly present at an advanced stage despite hormonal secretion. Primary tumor resection is associated with longer survival in stages as well as stage IV tumors.